Home Birth After
Caesarean (HBAC) Consent Form.
*Birthrites' Convenor
- Hi! You are welcome to use this form by copying it into a
processing file and then printing it. You just need to
delete these 'purple' words of mine prior to using the
form...
Time and again I have had women
approach me, feeling traumatised and bullied, after they
have attended an appointment to book into the hospital that
they have chosen as the 'future transfer' from a HBAC
&endash; in the case of an emergency.
The hospital staff have not
understood the women's choice of homebirth for her VBAC
attempt and, in their ignorance of her informed decision,
they have tried to change her mind. They often do so by
presenting her with each individual staff member's thoughts
on the risks she is taking in choosing this birth
environment for her VBAC attempt. Sometimes they present
research, though the woman may have more knowledge of the
risks involved from her own research. Sometimes they have
been known to use 'stand over' tactics.
In trying to alleviate these
situations I have put together a HBAC Consent Form, that
women can take with them to their hospital book-in
appointment. I've included it in the March 2001 issue of the
Birthrites Magazine, and I here on the Birthrites Website. I
only hope it helps both women and the hospital staff
understand each other a little better.
Birthing Beautifully,
Jackie Mawson
Home Birth After
Caesarean (HBAC) Consent Form.
The reason that a form such as this has become necessary,
is to encourage understanding and negotiation between a
woman, who has made an informed choice to have a HBAC, and
the medical system to which she may turn if intervention
(ie, transfer to hospital) is deemed necessary.
Please note:
The Royal College of Obstetricians and
Gynaecologists" guidelines state:
"That a woman's wishes must be taken into account even if
she is incompetent for the purposes of consent."
RCOG guidelines. Ethics. A consideration of the law and
ethics in relation to court-authorised obstetric
intervention. No 1. London: Royal College of Obstetricians
and Gynaecologists, 1994. (Supplement to No 1 published in
December 1996.)
The Cumberledge report on changing childbirth has
made society's mandate absolutely clear:
"Women are to be at the centre of decisions surrounding
their obstetric and midwifery care."
Cumberledge J. Changing childbirth. London: HMSO,
1993
Therefore, when a competent, properly informed woman
chooses a Home Birth After Caesarean (HBAC), as opposed to a
hospital VBAC, she should be supported in that choice. It is
her decision, as an informed adult aware of the risks
involved, to choose home birth as a viable option after
experiencing caesarean section/s.
This form outlines the woman's moral rights, and
highlights the main risk involved &endash; uterine rupture
and delay in technological intervention &endash; as a result
of the woman's chosen birth environment. It must be noted,
by hospital staff, that it is a patients right to refuse ANY
advice given, and the hospital has a duty of care regardless
of what decisions people make.
It's been shown, in a multitude of studies, that
successful, uncomplicated vaginal birth after caesarean
(VBAC) carries the lowest risk to both mother and baby as
compared to repeat elective caesarean section. The most
commonly reported success rate, for those attempting VBAC,
is about 75%. This statistic can be significantly altered by
the support the mother receives from her caregivers, with
the highest VBAC success statistics being achieved when the
mother is psychologically, and emotionally, supported during
a spontaneous, physiological, active labour.
Women may choose HBAC to avoid the interventions involved
in a VBAC birth within hospital &endash; outlined by the
hospital policies within each establishment. The policies
may be perceived by the mother as being psychologically
damaging, as they encourage fear and may decrease the
mother's faith in her ability to birth naturally. The
hospital VBAC policies are often used as 'safe guards' put
in place "…Just in case your uterus may rupture,
dear."
In this specific case, if the hospital staff listened to
the woman, her first choice may have been a hospital birth
with the midwife/independent midwife of her choice, and/or
with interventions being negotiated. This would seem the
perfect solution to the dilemma of the extra risks involved
with HBAC in regard to the time delay in an emergency. Why
shouldn't women be supported in their aim to have a
spontaneous, physiological VBAC within the safety of a
hospital labour ward, if that were their initial choice?
The most serious complication of attempting a VBAC
(anywhere) is uterine rupture, which is conservatively
quoted to occur in approximately 1% of cases. Women choosing
HBAC need to understand that in the event of signs of
uterine rupture, being at home may cause a delay in the
appropriate treatment.
Hospital staff need to be aware that women often choose
HBAC as a means of minimising the risks involved with VBAC
birth, by ensuring spontaneous labour, no
induction/augmentation, no epidural, etc. The mother has
made an informed decision, weighing the risks of both birth
environments and taking into account the policies involved
and the support she will receive. She recognises how these
factors will affect her labour, both physically and
emotionally.
By booking in, the woman seeks to facilitate a smooth
transition between home and hospital care if needed; the
woman is acting in a responsible way. She will have
researched the potential risks of HBAC (delay in the rare
event of rupture), and compared these with the
risks/disadvantages involved in a hospital VBAC - loss of
autonomy, adherence to rigid protocols that have no basis in
evidence, strangers caring for her at a time that she needs
dignity and privacy, etc. Her final decision of birth
environment is a HBAC; her contact with the hospital is only
to ensure essential personal records are available if
transfer should become necessary.
All informed women welcome further advice, but only if it
consists of unbiased information, and is fully referenced,
up-to-date, woman centred and evidence-based. Scare tactics
are of no benefit to either the woman or the professional
who presents them as 'research/facts'.
Therefore, basically, the consents/acknowledgements, that
indicate informed decisions by the Mother in her choice of
HBAC birth, are listed below. (Tick which are agreed, then
sign the form):
- My first choice would be:
A) A hospital birth with the midwife of my
choice, and/or with interventions (related to current
hospital policies) being negotiated. ______
- If this proves 'not possible' due to the
strictness of current hospital policies, then my
second choice of birth environment is:
- Birthcentre (if available to VBAC women)
______
- HBAC ______
OR
B) My first choice would be a Home Birth
After Caesarean (HBAC) with the midwife of my choice,
and/or with interventions being negotiated.
______
- I acknowledge there is a risk of uterine rupture,
rate of approximately 1%, and I endeavour to minimise
this risk by ensuring spontaneous labour, no
augmentation, no epidural and no unnecessary
interventions. ______
- I understand, and acknowledge, that in the event of
signs of uterine rupture, being at home may cause a delay
in commencing the appropriate treatment. ______
- I understand, and acknowledge, if this delay occurs,
due to HBAC choice and possible uterine rupture, it may
cause death/injury to my child or serious consequences to
myself. ______
- I also understand, and acknowledge, that by aiming
for a spontaneous, physiological labour (without
unnecessary interventions) I am significantly reducing my
risks of uterine rupture, regardless of my chosen birth
environment. ______
- I wish the hospital staff to acknowledge that, by
booking in during pregnancy, I seek to facilitate a
smooth transition between home and hospital care if the
need arises. ______
- Having acknowledged the potential risks of HBAC
(delay in the rare event of rupture), versus the
risks/disadvantages of hospital VBAC - loss of autonomy,
adherence to rigid protocols that have no basis in
evidence, strangers caring for me at a time I need
dignity and privacy etc, I choose HBAC as my birth
environment. This is an informed choice. ______
- I understand that you give recommendations in good
faith, but you must respect my right to reject that
advice if I see fit. ______
- I make these informed decisions as a competent adult.
______
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Patient's signature
_______________________
Print patient's name
__________________________
Attending Doctor's Name (signed and printed)
__________________________
Date
____________________________
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